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Mena AR, Thioubou MA, Diallo K, Tine J, Ngom NF, Fortes L, Ndiaye K, Karasi JC, Seguin-Devaux C, Goedertz H, Diouf D, Seydi M, Sambou BA, Arendt V, Wandeler G, Manga NM. Liver disease and treatment needs of asymptomatic persons living with hepatitis B in Senegal. Open Forum Infect Dis 2022; 9:ofac558. [DOI: 10.1093/ofid/ofac558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
The prevalence of active hepatitis B among asymptomatic persons remains unclear in Africa. Of 1,206 newly diagnosed persons in Senegal, 12.3% had significant fibrosis and 31.3% HBV DNA levels >2,000 IU/mL. Overall, 128 (12.9%) were eligible for antiviral therapy. Generalized HBV screening allowed the identification of a large population requiring HBV care.
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Affiliation(s)
- Adrià Ramírez Mena
- Department of Infectious and Tropical Diseases (SMIT), Fann University Hospital , Dakar , Senegal
- Department of Infectious Diseases, Bern University Hospital, University of Bern , Switzerland
- Graduate School of Health Sciences, University of Bern , Bern , Switzerland
| | - Mame Aissé Thioubou
- Department of Gastroenterology, Hôpital Universitaire de la Paix , Ziguinchor , Senegal
| | - Kalilou Diallo
- Department of Infectious Diseases, Hôpital Universitaire de la Paix , Ziguinchor , Senegal
| | - Judicael Tine
- Department of Infectious and Tropical Diseases (SMIT), Fann University Hospital , Dakar , Senegal
| | - Ndeye Fatou Ngom
- Centre de Traitement Ambulatoire, Fann University Hospital , Dakar , Senegal
| | - Louise Fortes
- Department of Infectious and Tropical Diseases (SMIT), Fann University Hospital , Dakar , Senegal
| | - Kiné Ndiaye
- Centre de Traitement Ambulatoire, Fann University Hospital , Dakar , Senegal
| | - Jean-Claude Karasi
- Department of Infectious Diseases, Centre Hospitalier du Luxembourg , Luxembourg
| | | | - Henri Goedertz
- Department of Infectious Diseases, Centre Hospitalier du Luxembourg , Luxembourg
| | | | - Moussa Seydi
- Department of Infectious and Tropical Diseases (SMIT), Fann University Hospital , Dakar , Senegal
| | | | - Vic Arendt
- Department of Infectious Diseases, Centre Hospitalier du Luxembourg , Luxembourg
| | - Gilles Wandeler
- Department of Infectious and Tropical Diseases (SMIT), Fann University Hospital , Dakar , Senegal
- Department of Infectious Diseases, Bern University Hospital, University of Bern , Switzerland
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Noël Magloire Manga
- Department of Infectious Diseases, Hôpital Universitaire de la Paix , Ziguinchor , Senegal
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Gras A, Yegles M, Karasi JC, Schmit JC, Seguin-Devaux C, Schneider S. Simultaneous quantification of zidovudine, stavudine, lamivudine and nevirapine by Micellar Electrokinetic Capillary Chromatography. ACTA ACUST UNITED AC 2013. [DOI: 10.1051/ata/2012024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Radloff R, Gras A, Zanger UM, Masquelier C, Arumugam K, Karasi JC, Arendt V, Seguin-Devaux C, Klein K. Novel CYP2B6 enzyme variants in a Rwandese population: functional characterization and assessment of in silico prediction tools. Hum Mutat 2013; 34:725-34. [PMID: 23418033 DOI: 10.1002/humu.22295] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 02/05/2013] [Indexed: 01/11/2023]
Abstract
Cytochrome P450 CYP2B6 is a highly polymorphic enzyme that metabolizes numerous drugs, pesticides, and environmental toxins. Sequence analysis of a Rwandese population identified eight functionally uncharacterized nonsynonymous variants c.329G>T (p.G110V), c.341T>C (p.I114T), c.444G>T (p.E148D), c.548T>G (p.V183G), c.637T>C (p.F213L), c.758G>A (p.R253H), c.835G>C (p.A279P), and c.1459C>A (p.R487S), and five novel alleles termed CYP2B6*33 to CYP2B6*37 were assigned. Recombinant expression in COS-1 cells and functional characterization using the antidepressant bupropion and the antiretroviral efavirenz (EFV) as substrates demonstrated complete or almost complete loss-of-function for variants p.G110V, p.I114T, p.V183G, and p.F213L, whereas p.E148D, p.R253H, p.A279P, and p.R487S variants were functional. The data were used to assess the predictive power of eight online available functional prediction programs for amino-acid changes. Although none of the programs correctly predicted the functionality of all variants, substrate docking simulation analyses indicated similar conformational changes by all four deleterious mutations within the enzyme's active site, thus explaining lack of enzymatic function for both substrates. Because low-activity alleles of CYP2B6 are associated with impaired EFV metabolism and adverse drug response, these results are of potential utility for personalized treatment strategies in HIV/AIDS therapy.
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Affiliation(s)
- Robert Radloff
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
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Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, Weigel JL, Farmer DB, Habinshuti A, Mugeni SD, Karasi JC, Drobac PC. Reduced premature mortality in Rwanda: lessons from success. BMJ 2013; 346:f65. [PMID: 23335479 PMCID: PMC3548616 DOI: 10.1136/bmj.f65] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rwanda’s approach to delivering healthcare in a setting of post-conflict poverty offers lessons for other poor countries, say Paul Farmer and colleagues
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Affiliation(s)
- Paul E Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Gras A, Schneider S, Karasi JC, Ternes AM, Sauvageot N, Karasi-Omes C, Henry AP, Schmit JC, Seguin-Devaux C, Arendt V. Evaluation of saliva as an alternative matrix for monitoring plasma Zidovudine, Lamivudine and nevirapine concentrations in Rwanda. Curr HIV Res 2011; 9:223-8. [PMID: 21671885 DOI: 10.2174/157016211796320270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/10/2011] [Indexed: 11/22/2022]
Abstract
Saliva may provide interesting advantages as matrix for compliance measurements, pharmacokinetic studies and therapeutic drug monitoring in resource limited countries. We investigated the feasibility of using saliva for compliance monitoring of zidovudine (ZDV), lamivudine (3TC) and nevirapine (NVP) in 29 HIV-1 infected patients from Rwanda. ZDV, 3TC and NVP drug levels were quantified by an LC/MS-MS method in plasma and stimulated saliva samples and compared using Bland-Altman analysis. Seven patients demonstrated undetectable saliva ZDV levels while five out of these seven also showed no 3TC salivary concentrations. For the other samples, we observed a good agreement between salivary and plasma concentrations of each antiretroviral drug. A significant relation between the difference in saliva and plasma ZDV concentrations and the average ZDV concentration in the two matrices was deduced as follow: y = -380.15 + 1.79 x. The log saliva and plasma concentration difference of both 3TC and NVP was consistent across the range of average log concentration. Overall, we showed large agreement limits suggesting a wide inter patient variability that may result to non-reliable plasma level predictions from saliva drug measurements. Therefore, our results indicate that saliva may serve as a valuable tool only for NVP compliance testing because of its high salivary concentration.
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Affiliation(s)
- Alain Gras
- Laboratory of Retrovirology, CRP-Santé, Luxembourg.
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Abstract
The Global Fund Against AIDS, Tuberculosis and Malaria (GFATM) approved only three 'health systems strengthening' projects ever, one of them in Rwanda. This project intends to enhance financial access to health care by subsidising health insurance for the poor in order to combat the three diseases successfully. It was submitted to a mid-term evaluation in 2007. The findings of this evaluation are presented and triangulated with experience gained through several years of membership in the Rwandan Country Coordinating Mechanism and the multi-stakeholder 'Working Group on Mutuelles': The GFATM-funded project improved dramatically the financial access of its target group, the very poor--reaching approximately one Rwandan in six. Because of the established rigid regulatory framework, its impact on other population strata was more ambiguous. Improved financial access went hand-in-hand with growing health service utilisation and improvements in the population's health status, including better control of AIDS, tuberculosis and malaria. This success was achieved with limited financial resources. In consequence, interventions that strengthen health systems should always be considered for a prominent--if not a priority role--in GFATM-funded projects.
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Hübschen JM, Mugabo J, Peltier CA, Karasi JC, Sausy A, Kirpach P, Arendt V, Muller CP. Exceptional genetic variability of hepatitis B virus indicates that Rwanda is east of an emerging African genotype E/A1 divide. J Med Virol 2009; 81:435-40. [PMID: 19152415 DOI: 10.1002/jmv.21412] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In Western Africa, hepatitis B virus (HBV) genotype E predominates throughout a vast crescent spanning from Senegal to Namibia and at least to the Central African Republic to the East. Although from most of the eastern parts of sub-Saharan Africa only limited sets of strains have been characterized, these belong predominantly to genotype A. To study how far the genotype E crescent extends to the East, a larger number of HBV strains from Rwanda were analyzed. Phylogenetic analysis of 45 S fragment sequences revealed strains of genotypes A (n = 30), D (n = 10), C (n = 4), and B (n = 1). Twelve genotype A sequences formed a new cluster clearly separated from the reference strains of the known sub-genotypes. Thus, with four genotypes and at least six sub-genotypes and a new cluster of genotype A strains, HBV shows an exceptional genetic variability in this small country, unprecedented in sub-Saharan Africa. Despite this exceptional genetic variability, not a single genotype E virus was found indicating that this country does not belong to the genotype E crescent, but is east of an emerging African genotype E/A1 divide.
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Affiliation(s)
- Judith M Hübschen
- Institute of Immunology, Laboratoire National de Santé/Centre de Recherche Public de Santé, Luxembourg, Luxembourg
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Masquelier C, Servais JY, Rusanganwa E, Roman F, Havuga E, Servais J, Tuyizere S, Omes C, Karasi JC, Coruteille O, Karita E, Allen S, Schmit JC, Arendt V. A novel 24-base pair deletion in the coding region of CCR5 in an African population. AIDS 2007; 21:111-3. [PMID: 17148978 DOI: 10.1097/01.aids.0000254687.86122.fa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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